Provider Demographics
NPI:1033749809
Name:JONES, FREDRED HENRY JR
Entity Type:Individual
Prefix:MR
First Name:FREDRED
Middle Name:HENRY
Last Name:JONES
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9729 PARKWAY E STE 10
Mailing Address - Street 2:
Mailing Address - City:CENTER POINT
Mailing Address - State:AL
Mailing Address - Zip Code:35215-7800
Mailing Address - Country:US
Mailing Address - Phone:205-821-8102
Mailing Address - Fax:205-208-1191
Practice Address - Street 1:9729 PARKWAY E STE 10
Practice Address - Street 2:
Practice Address - City:CENTER POINT
Practice Address - State:AL
Practice Address - Zip Code:35215-7800
Practice Address - Country:US
Practice Address - Phone:205-821-8102
Practice Address - Fax:205-208-1191
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-21
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1715247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1134529217Medicaid